Mortality in adults with multidrug-resistant tuberculosis and HIV by antiretroviral therapy and tuberculosis drug use: an individual patient data meta-analysis

HIV-infection is associated with increased mortality during multidrug-resistant tuberculosis treatment, but the extent to which the use of antiretroviral therapy (ART) and anti-tuberculosis medications modify this risk are unclear. Our objective was to evaluate how use of these treatments altered mo...

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Veröffentlicht in:The Lancet (British edition) Jg. 396; H. 10248; S. 402 - 411
Hauptverfasser: Bisson, Gregory P, Bastos, Mayara, Campbell, Jonathon R, Bang, Didi, Brust, James C, Isaakidis, Petros, Lange, Christoph, Menzies, Dick, Migliori, Giovanni B, Pape, Jean W, Palmero, Domingo, Baghaei, Parvaneh, Tabarsi, Payam, Viiklepp, Piret, Vilbrun, Stalz, Walsh, Jonathan, Marks, Suzanne M
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Elsevier Ltd 08.08.2020
Elsevier B.V
Elsevier Limited
Schlagworte:
Adult
Adults
Analysis
Anti-HIV Agents - therapeutic use
Antibiotics
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antitubercular agents
Antitubercular Agents - therapeutic use
Antiviral agents
Bacilli
Data analysis
Datasets
Death
Disease control
Drug resistance
Drug resistance in microorganisms
Drugs
Female
Health aspects
Health risks
Health services
Highly active antiretroviral therapy
HIV
HIV (Viruses)
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - mortality
Human immunodeficiency virus
Humans
Infectious diseases
Levofloxacin
Linezolid
Male
Matching
Meta-analysis
Mortality
Mortality risk
Moxifloxacin
Multidrug resistance
Multidrug resistant organisms
Regression analysis
Respiration
Risk Factors
Sexually transmitted diseases
STD
Systematic review
Therapy
Thorax
Tuberculosis
Tuberculosis, Multidrug-Resistant - complications
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - mortality
ISSN:0140-6736, 1474-547X, 1474-547X
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Zusammenfassung:HIV-infection is associated with increased mortality during multidrug-resistant tuberculosis treatment, but the extent to which the use of antiretroviral therapy (ART) and anti-tuberculosis medications modify this risk are unclear. Our objective was to evaluate how use of these treatments altered mortality risk in HIV-positive adults with multidrug-resistant tuberculosis. We did an individual patient data meta-analysis of adults 18 years or older with confirmed or presumed multidrug-resistant tuberculosis initiating tuberculosis treatment between 1993 and 2016. Data included ART use and anti-tuberculosis medications grouped according to WHO effectiveness categories. The primary analysis compared HIV-positive with HIV-negative patients in terms of death during multidrug-resistant tuberculosis treatment, excluding those lost to follow up, and was stratified by ART use. Analyses used logistic regression after exact matching on country World Bank income classification and drug resistance and propensity-score matching on age, sex, geographic site, year of multidrug-resistant tuberculosis treatment initiation, previous tuberculosis treatment, directly observed therapy, and acid-fast-bacilli smear-positivity to obtain adjusted odds ratios (aORs) and 95% CIs. Secondary analyses were conducted among those with HIV-infection. We included 11 920 multidrug-resistant tuberculosis patients. 2997 (25%) were HIV-positive and on ART, 886 (7%) were HIV-positive and not on ART, and 1749 (15%) had extensively drug-resistant tuberculosis. By use of HIV-negative patients as reference, the aOR of death was 2·4 (95% CI 2·0–2·9) for all patients with HIV-infection, 1·8 (1·5–2·2) for HIV-positive patients on ART, and 4·2 (3·0–5·9) for HIV-positive patients with no or unknown ART. Among patients with HIV, use of at least one WHO Group A drug and specific use of moxifloxacin, levofloxacin, bedaquiline, or linezolid were associated with significantly decreased odds of death. Use of ART and more effective anti-tuberculosis drugs is associated with lower odds of death among HIV-positive patients with multidrug-resistant tuberculosis. Access to these therapies should be urgently pursued. American Thoracic Society, Canadian Institutes of Health Research, US Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America.
Bibliographie:ObjectType-Article-1
ObjectType-Evidence Based Healthcare-3
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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DM conceptualised and oversees the individual participant data project as principal investigator. GPB, MB, JRC, JW, and SMM designed the study and protocol, which all authors approved. DB, JCB, PI, CL, GBM, JWP, DP, PB, PT, PV, SV, and SMM contributed data to the meta-analysis. MB and JRC performed the data analysis. GPB wrote the initial draft of the manuscript, and all authors provided critical input and revisions to the draft manuscripts and approved the final manuscript.
Contributors
ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(20)31316-7